Internal Medicine Department, Hospital de Manises, Valencia, Spain.
Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
Eur J Intern Med. 2019 Feb;60:18-23. doi: 10.1016/j.ejim.2018.10.010. Epub 2018 Oct 22.
The value of digoxin in heart failure (HF) remains controversial, particularly in patients with preserved ejection fraction (HFpEF). This study evaluated the 1-year risk of events after digoxin treatment for acute heart failure (AHF) in patients >70 years old with HFpEF.
1833 patients were included in this analysis (mean age, 82 years). The main endpoints were all-cause death and the composite of death and/or HF re-admission within 1 year. Cox regression analysis was used to evaluate the association between digoxin treatment and prognosis.
401 patients received digoxin treatment; of these, 86% had atrial fibrillation. The mean baseline heart rate was 86 ± 22 bpm. At the 1-year follow-up, 375 patients (20.5%) died and 684 (37.3%) presented composite endpoints. Patients treated with digoxin showed higher rates of death (3.21 vs. 2.44 per 10 person-years, p = .019) and composite endpoint (6.72 vs. 5.18 per 10 person-years, p = .003). After multivariate adjustment, digoxin treatment remained associated with increased risks of death (HR = 1.46, 95% CI: 1.16-1.85, p = .001) and the composite endpoint (HR = 1.35, 95% CI: 1.13-1.61, p = .001). A distinctive prognostic effect of digoxin was found across the heart rate continuum; the risks for both endpoints were higher at lower heart rates and neutral at higher heart rates (p of the interactions = 0.007 and 0.03, respectively).
In older patients with HFpEF discharged after AHF, digoxin treatment was associated with increased mortality and/or re-admission, particularly in patients with lower heart rates.
地高辛在心力衰竭（HF）中的价值仍存在争议，特别是在射血分数保留的心力衰竭（HFpEF）患者中。本研究评估了地高辛治疗急性心力衰竭（AHF）后 1 年对>70 岁 HFpEF 患者发生事件的风险。
本分析纳入 1833 例患者（平均年龄 82 岁）。主要终点为 1 年内全因死亡和死亡和/或心力衰竭再入院的复合终点。采用 Cox 回归分析评估地高辛治疗与预后的关系。
401 例患者接受地高辛治疗；其中 86%患有心房颤动。平均基线心率为 86±22bpm。在 1 年随访时，375 例患者（20.5%）死亡，684 例患者出现复合终点。接受地高辛治疗的患者死亡率更高（每 10 人年 3.21 比 2.44，p=0.019）和复合终点发生率更高（每 10 人年 6.72 比 5.18，p=0.003）。经过多变量调整后，地高辛治疗仍与死亡风险增加相关（HR=1.46，95%CI：1.16-1.85，p=0.001）和复合终点（HR=1.35，95%CI：1.13-1.61，p=0.001）。在地高辛治疗的风险与心率连续体之间存在明显的预后相关性；在较低心率时，两个终点的风险更高，在较高心率时风险为中性（交互作用的 p 值分别为 0.007 和 0.03）。
在 AHF 出院后 HFpEF 的老年患者中，地高辛治疗与死亡率和/或再入院增加相关，尤其是在心率较低的患者中。
